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Individual

CHARLENE J. JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
416 W 27TH ST, ASHTABULA, OH 44004-4975
(440) 997-5427
(440) 997-5486
Mailing address
416 W 27TH ST, ASHTABULA, OH 44004-4975
(440) 997-5427
(440) 997-5486

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT01263
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0747777
OH
Enumeration date
03/21/2007
Last updated
08/15/2024
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